Pediatric Asthma Exacerbation

09:00: 7-year-old male arrives via EMS with mother. Mother reports child has been coughing and wheezing since early morning. Patient has a history of moderate persistent asthma. Home medications include daily fluticasone and albuterol as needed. Mother states he has used his albuterol inhaler 4 times in the last 2 hours without significant relief. Patient appears anxious, is sitting upright, and leaning forward. Audible wheezing noted. Lung sounds reveal diminished breath sounds in the bases and high-pitched expiratory wheezing throughout.